Provider Demographics
NPI:1861823577
Name:ISLAND FAMILY CHIROPRACTIC WELLNESS PLLC
Entity Type:Organization
Organization Name:ISLAND FAMILY CHIROPRACTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-663-8299
Mailing Address - Street 1:62 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-6019
Mailing Address - Country:US
Mailing Address - Phone:845-663-8299
Mailing Address - Fax:
Practice Address - Street 1:400 KINGS MALL CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1578
Practice Address - Country:US
Practice Address - Phone:846-663-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty